Ob/Gyn Blueprints & ACOG Flashcards
What should all patients with bleeding during pregnancy receive?
Blood test for Rh status
If negative give RhoGAM to prevent isoimmunization
What is terbutaline used for?
Beta 2 agonist
Used to relax the uterus in cases of uterine hypertonus or tachysystole (>5 contractions/10min)
What are non-reassuring fetal signs, and how should patient be managed?
Repetitive late decelerations, bradycardias, and loss of variability
Face mask O2, place on left side to relieve IVC
What are the three signs placental separation?
Cord lengthening, gush of blood, fundal rebound
What does posterior succenturiate lobe? put patients at risk for?
Vasa previa
What does sinusoidal pattern on continuous FHR monitoring suggest? What should be done?
Fetal anemia usually from vasa previa rupture
Emergent delivery
What are classic findings of uterine rupture?
Severe abdominal pains with loss of station of fetal head in actively laboring patient with history of C-section
What is the MoA of Mg in decreasing contractions? What are possible side effects?
Antagonizes calcium and stabilizes cell membranes
Flushing, diplopia, headache
What are associated with increased risk for breech presentation?
Fetal anomalies like anencephaly and hydrocephaly
Uterine anomalies like oligo and polyhydramnios
What are the initial steps in treating a patient presenting with eclampsia (seizing and HTN)?
- ABCs
- IV Mg
- IV labetalol or hydralazine
HTN early in 2nd trimester?
Hydatidiform mole and previous chronic hypertension
What testing should be done in women over 30-65 with negative pap and HPV?
Next pap HPV in 5 years
What testing should be done in women over 30-65 with negative pap and HPV?
Next pap HPV in 5 years
How do you diagnose gestational hypertension?
elevated BPs (> 140/90 mm Hg) after 20 weeks’ gestation
What is the next most important step in management of a patient with HELLP?
This is a subtype of severe preeclampsia, must induce labor if at 32-34 weeks.
What is true gestational diabetes and how does it arise>?
impairment of carbohydrate metabolism that manifests during pregnancy
human placental lactogen act as anti-insulin agents leading to increased insulin resistance
What are signs and sx of intra amniotic infection, and what needs to be done? I
Fever, tender fundus, elevated WBC
Induction of labor if normal FHT
Contraindications to using Mg sulfate?
Myasthenia gravis
Side effects of terbutaline?
Tachycardia hypotension anxiety and chest pain
What are the karyotypes for a partial mole? Ultrasound finding?
Triploid 69 xxx(y)
Marked villi swelling
Which moles put patients at increased risk of GTD?
Complete moles
What are the signs of metastatic gestational trophoblastic disease and what should be done?
Elevated beta HCg, no evidence of IUP,
CT c/a/p
What is the appropriate of management of cord prolapse in a laboring patient?
Lift fetal head and perform emergent c section
What is the treatment for VIN 3?
Wide local excision
What should be done if patient has ASCUS but is negative for high risk HPV?
Resume normal screening, Pap again in 3 years
What is most concerning finding on colposcopy?
Disorderly blood vessels
What should be done for HSIL if nothing found on ECC?
Cervical conization
What should be done for patients presenting with positive ECC?
Cervical conization
What is Meigs syndrome?
Triad of ovarian tumor,ascites, and Right hydrothorax
What is the usual ratio of FSH/LH in primary ovarian failure and why?
> 1 because both elevated but FSH cleared slower
What is the best management for patient at 42 weeks with favorable cervix and no contractions?
admit for induction
What is polyhydramnios with rapid decompression of intrauterine cavity put the patient at risk for?
placental abruption
What is the most likely cause of vaginal bleeding and friable cervix on exam in a pregnant woman?
Cervicitis
What utero-tonic agent is contraindicated in mother’s with asthma?
Prostaglandin F2-alpha - potent smooth muscle constrictor with effects on bronchi
What can prostaglandin F2 alpha be used for? Prostaglandin E1?
F2 alpha = uterotonic agent
E1 = cervical ripening
What are main associations with intrauterine fetal growth restriction (3rd TM)?
Fetal demise, perinatal demise, meconium aspiration, polycythemia, oligohydramnios
What is the appropriate management of intrauterine growth restriction?
Antenatal testing of fetal well being–> NST twice weekly, weekly AFI, weekly BPP
What are associated findings of Mitral valve prolapse, and how should it be treated in pregnancy?
Chest pain, palpitations, systolic ejection murmur with a click,
treat with beta-blockers
What are the risks to the fetus in twin-twin transfusion syndrome?
high morbidity and mortality in both, neurological sequelae in surviving twin
A decrease in which hormones after delivery stimulate milk production?
Progesterone and estrogen (relieves inhibitory influence on production of alpha-lactalbumin by the rough endoplasmic reticulum)
What is the main abnormality caused by valproate in pregnancy?
Neural Tube defects
What is the utility of the fetal fibronectin test in women with pre-term contractions?
99% NPV if patient is symptomatic –> thus 99% with negative result will not deliver in next 14 days
What is the most important lab test to check with any pregnant woman with vaginal bleeding?
Type and screen -> to identify if RhoGAM needs to be administered
What is the most important treatment for pregnant women in 3rd TM with newly diagnosed HIV, to prevent newborn transmission?
IV zidovudine at the time of delivery, along with starting HAART
What is the goal of diastolic blood pressure reduction in a preeclamptic patient with bp 200+/100+?
reduce to 90-95 diastolic range, harm reduction
What is the treatment for fetal hydrops from Rh disease in the case of severe hemolytic disease?
attempt intrauterine intravascular fetal transfusion
What are associated non gyn findings in patients with lichen planus?
oral lesions, alopecia and extragenital rashes
When can manual vacuum aspiration be done in pregnancy?
before 8 weeks to terminate
What are the risk factors for developing pelvic organ prolapse?
increasing parity, increasing age, obesity, some connective tissue disorders (Ehlers-Danlos syndrome), and chronic constipation, vaginal > c section
What should be done for HSIL, with positive acetowhite staining on colpo, but negative ECC?
Cold knife conization, to see specimen from within os and assess for lesions
What should be done for a woman who presents in early first TM with heavy vaginal bleeding and severe anemia?
immediate D&C to remove products of conception and evaluate bleed
